Department of Radiology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Thromb Haemost. 2012 Aug;108(2):384-93. doi: 10.1160/TH11-07-0452. Epub 2012 Jun 28.
Identification of patients with acute pulmonary embolism (PE) who might be at risk of circulatory collapse by using a fast, automated system is highly desired. It was our objective to investigate whether automated cardiac volumetric analysis following computerised tomographic pulmonary angiography (CTPA) is useful to identify increased clot load and adverse prognosis in patients with acute PE. We retrospectively analysed a consecutive series of non-gated CTPA studies of 124 patients with acute PE and 43 controls. Right and left ventricular diameters (RV/LV) were measured on four-chamber view, while each cardiac chamber underwent automatic volumetric measurements. Findings were correlated to the pulmonary arterial obstruction index (PAOI). Outcome was expressed by admission to an intensive care unit (ICU) or mortality within 30 days. There was a significant positive correlation between the PAOI and the volumes of the right side cavities (r=0.25 for the atrium and r=0.49 for the ventricle), and between the right-to-left atrial and ventricular volume ratios (r=0.49 and r=0.57, respectively). Results for the combined outcome of mortality or ICU admission that fell in the upper tertile of the right atrial and right ventricular volumes yielded hazard ratios of 3.9 and 3.3, respectively, compared to those in the lower tertile. RV/LV diameter ratio did not correlate with outcome. In conclusion, adverse outcome and significant pulmonary clot load in patients with acute PE are associated with a volume shift towards right heart cavities, which correlates to prognosis better than the CT-measured RV/LV diameter ratio, suggesting the advantage of using fast fully automatic volumetric analysis to identify patients at risk.
通过使用快速、自动化的系统来识别可能发生循环衰竭的急性肺栓塞（PE）患者，这是非常需要的。我们的目的是研究计算机断层肺动脉造影（CTPA）后自动心脏容积分析是否有助于识别急性 PE 患者的血栓负荷增加和不良预后。我们回顾性分析了 124 例急性 PE 患者和 43 例对照患者的连续非门控 CTPA 研究。在四腔心视图上测量右心室和左心室直径（RV/LV），同时对每个心腔进行自动容积测量。结果与肺动脉阻塞指数（PAOI）相关。结果表示为入住重症监护病房（ICU）或 30 天内死亡。PAOI 与右心腔容积（心房为 0.25，心室为 0.49）之间存在显著正相关，右心房与心室容积比（分别为 0.49 和 0.57）之间也存在显著正相关。右心房和右心室容积处于上三分位的患者，其死亡率或入住 ICU 的联合结局发生率，与下三分位患者相比，分别具有 3.9 和 3.3 的风险比。RV/LV 直径比与结果无相关性。总之，急性 PE 患者的不良结局和显著的肺血栓负荷与右心腔容积的转移有关，与 CT 测量的 RV/LV 直径比相比，其与预后的相关性更好，这表明使用快速全自动容积分析来识别高危患者具有优势。
